Neurosyphilis Presenting with Non-Convulsive Status Epilepticus

Neurosyphilis is an infectious disease of the central nervous system caused by Treponema pallidum spirochete. There are several case reports on atypical manifestations of neurosyphilis, involving progressive cognitive dysfunction and seizures similar to those in herpes encephalitis. Seizures are common in patients with neurosyphilis, but they are usually associated with a positive Jarisch-Herxheimer reaction and status epilepticus is atypical as an initial manifestation of neurosyphilis. Here, we report on neurosyphilis patient whose initial symptom was nonconversive status epilepticus.

Postictal Prosopometamorphopsia after Focal Status Epilepticus due to Cavernous Hemangioma in the Right Occipital Lobe

No abstract available.

Intravenous administration of EGB 761 and 90-day functional outcome in patients with acute ischemic stroke

Background & Objective: EGB 761 is a standardized natural extract used to treat impaired cerebral perfusion and nutrition (cerebrovascular insufficiency) in Korea. Although several animal studies have been conducted, few studies have investigated the clinical effects of EGB 761 in acute stroke. This study assessed the clinical benefit of intravenous EGB 761 in patients with acute ischemic stroke. Methods: This retrospective study examined a prospectively collected stroke database. We evaluated 232 patients with acute ischemic stroke within 48 hours of symptom onset. All patients were treated with antiplatelet or anticoagulation agents. We compared baseline characteristics between the EGB 761-treated and non-treated groups. The functional outcome measure was the modified Rankin Scale (mRS) score 90 days after stroke onset. Results: Of the 232 patients, 170 received EGB 761 during the first 3 days after arrival in the emergency department. We found no significant differences in baseline characteristics between the groups, with the exception of atrial fibrillation (p=0.032). After adjusting for baseline factors, intravenous administration of EGB 761 was associated with an improved 90-day functional outcome (mRS ≤2) compared with the control group (odds ratio, 2.56; p<0.05). Conclusions: Our results showed a clinical benefit of intravenous EGB 761 in patients with acute ischemic stroke

Association between carotid intima-media thickness and Ankle-Brachial Index in patients with ischemic stroke / 동물의과학연구지

BACKGROUND AND PURPOSE: The Ankle-Brachial Index (ABI) is the ratio of blood pressure in the lower legs to that in the arms. The intima-media thickness (IMT) of extracranial carotid arteries determined by B-mode ultrasound is a measurable index of the presence of atherosclerosis. A low ABI and a high carotid IMT are independently related to increased risk of cardiovascular events. This study examined the association between carotid IMT and ABI in patients with ischemic stroke. MATERIALS AND METHODS: Retrospectively, 116 hospitalized patients with ischemic stroke were recruited. Using a pulse wave velocity ABI device along with carotid duplex sonography, we measured carotid IMT and ABI and investigated the correlation between average values. RESULTS: There was a significant difference in carotid IMT between the normal and abnormal ABI groups (P=0.0262). The group with an abnormal ABI was more than five times as likely to have increased carotid IMT as the group with a normal ABI (age, sex-adjusted OR 5.67 (95% CI 1.85~17.38)). The ABI and carotid IMT showed a weak inverse linear correlation in patients with ischemic stroke (correlation coefficient -0.378 after adjusting for age and sex). CONCLUSION: Our study suggests that an abnormal ABI is associated with a high carotid IMT in patients with ischemic stroke.

Cavernous Sinus Dural Arteriovenous Fistula Mimicking Tolosa-Hunt Syndrome

No abstract available.

Dumping Syndrome in an Adult Patient Receiving Gastrostomy Feeding With Persistent Vegetative State

No abstract available.

Cervical epidural hematoma mimicking a transient ischemic attack: A report of two cases

Spontaneous cervical epidural hematoma (SCEH) is a rare condition that causes paraparesis or quadriparesis. As spontaneous resolution is seldom expected, it usually requires surgical treatment for relieve symptoms. Even if spontaneous resolution occurs, relief from symptoms usually requires several hours to days. In contrast, hemiparesis is the most common symptom of a transient ischemic attack (TIA), and usually resolves over minutes to hours. We report here two patients with SCEH who presented with hemiparesis with severe neck pain. Both patients were taking antiplatelet drugs. Their neurological symptoms recovered spontaneously over a very short time. They were initially misdiagnosed as TIA. These cases show that patients with transient hemiparesis may have SCEH if there is severe neck pain and no cranial nerve involvement.

Nonconvulsive Status Epilepticus Caused by Cephalosporins in Patients with Renal Failure / 대한간질학회지

PURPOSE: To describe the clinical features of nonconvulsive status epilepticus (NCSE) associated with cephalosporins in patients with renal failure and to emphasize the importance of EEG in diagnosing NCSE in patients with altered consciousness. METHODS: We described the detailed clinical characteristics of 8 patients with renal failure who underwent cephalosporin-induced NCSE. RESULTS: Six of the patients showed unresponsiveness with preserved alertness and two patients presented confusion and irritability. 6 patients presented altered consciousness with intermittent jerky movements of face or arms. Altered consciousness developed 6+/-5 days (mean+/-SD) after starting the above antibiotics. The EEG showed continuous generalized high voltage 1.0 to 2.5 Hz sharp waves or sharp and wave complexes. All patients improved 3+/-1 days after withdrawing the offending antibiotics without administration of antiepileptic drugs. CONCLUSIONS: Cephalosporin-induced NCSE should be differentiated from metabolic encephalopathy in patients with renal failure, which is clinically difficult. Early detection with EEG and withdrawal of the offending antibiotics can result in full recovery.

Spontaneous Spinal Epidural Hematoma in a Patient on Cilostazol / 대한뇌졸중학회지

Cilostazol is a phosphodiesterase inhibitor that has been shown to have similar efficacy in stroke prevention but fewer hemorrhagic events compared with aspirin. We report a case of spontaneous spinal epidural hematoma (SSEH) in a 67-year-old woman who has been treated with cilostazol for cerebral infarction. The patient was presented with sudden neck pain and right hemiparesis. Thirteen days after the onset, she recovered completely. Even cilostazol, which is a relatively safer drug in terms of bleeding risk compared to other antiplatelet agents, may cause SSEH. Therefore, physicians should keep in mind rare, but potentially fatal, bleeding complications such as SSEH when prescribing antiplatelet agents.

Nonconvulsive Status Epilepticus Caused by Cephalosporins in Patients with Renal Failure

PURPOSE: To describe the clinical features of nonconvulsive status epilepticus (NCSE) associated with cephalosporins in patients with renal failure and to emphasize the importance of EEG in diagnosing NCSE in patients with altered consciousness.METHODS: We described the detailed clinical characteristics of 8 patients with renal failure who underwent cephalosporin-induced NCSE.RESULTS: Six of the patients showed unresponsiveness with preserved alertness and two patients presented confusion and irritability. 6 patients presented altered consciousness with intermittent jerky movements of face or arms. Altered consciousness developed 6+/-5 days (mean+/-SD) after starting the above antibiotics. The EEG showed continuous generalized high voltage 1.0 to 2.5 Hz sharp waves or sharp and wave complexes. All patients improved 3+/-1 days after withdrawing the offending antibiotics without administration of antiepileptic drugs.CONCLUSIONS: Cephalosporin-induced NCSE should be differentiated from metabolic encephalopathy in patients with renal failure, which is clinically difficult. Early detection with EEG and withdrawal of the offending antibiotics can result in full recovery.

Anti-NMDA Receptor Encephalitis

A severe, but reversible encephalitis associated with antibodies to the N-methyl-D-aspartate receptor (NMDAR) was identified recently in young women with ovarian teratoma. This condition has not been reported previously in Korea. A 31-year-old woman presented with fever and behavioral disturbances; she became comatose several days later, and dyskinesia and dysautonomia developed thereafter. Antibodies to the NMDAR were positive and abdominal computed tomography detected a large ovarian teratoma. The patient improved dramatically after the removal of the teratoma and administration of corticosteroid therapy.

Listeria monocytogenes Myelitis

Listeria myelitis is known to be very rare and not reported yet in Korea. A 78-year-old man with diabetes mellitus and hepatocellular carcinoma presented altered mentality, paraparesis, and fever. His spinal cord MRI, cerebrospinal fluid study, and blood culture demonstrated thoracic myelitis caused by Listeria monocytogenes. This case suggests that listeria myelitis should be considered as one of the causes of non-tumorous myelopathy especially in immunocompromised patients.

Large Aneurysm of the Internal Carotid Artery Presenting as Bitemporal Hemianopia / 대한뇌졸중학회지

No abstract available.

Reversible Splenium Lesion of the Corpus Callosum in Hemorrhagic Fever with Renal Failure Syndrome

This is the first case of virus-associated encephalitis/encephalopathy in which the pathogen was Hantaan virus. A 53-yr-old man presented fever, renal failure and a hemorrhagic tendency and he was diagnosed with hemorrhagic fever with renal failure syndrome (HFRS). In the course of his illness, mild neurologic symptoms such as dizziness and confusion developed and magnetic resonance images revealed a reversible lesion in the splenium of the corpus callosum. This case suggests that HFRS patients with neurologic symptoms like dizziness and mental slowing should be considered to have structural brain lesions and to require brain imaging studies.

Paroxysmal pruritus as the fi rst relapsing symptom of neuromyelitis optica

Itching is a rare symptom in neurological disease. Paroxysmal symptom is uncommon in neuromyelitis optica (NMO) or multiple sclerosis. We describe a 45-year-old woman who presented with paroxysmal pruritus in association with relapse of NMO on two separate occasions. Cervical MRI showed a lesion at a level corresponding to the dermatomal site of the itching. Paroxysmal pruritus could be a predictive symptom of relapse in NMO unless there are other comorbid causes such as systemic diseases, allergy, drug reaction, or emotional stress responsible for the itching.

A Case of Cerebral Venous Thrombosis as the Presenting Sign of Occult Prostate Cancer

BACKGROUND: Cerebral venous thrombosis (CVT) is a distinct disorder with highly variable symptoms and courses. Malignancy is known to be one of the predisposing factors of CVT. CASE REPORT: We present the case of a 69-year-old man with sudden behavioral changes. Brain MRI, magnetic resonance venography, and positive D-dimer assay confirmed the presence of CVT. The work-up for detecting the cause of the CVT revealed occult prostate cancer. CONCLUSIONS: Occult malignancy including prostate cancer should be strongly suspected in older patients with idiopathic CVT.

Postpartum Bilateral Obturator Neuropathy

No abstract available.